THERAPEUTIC COACHING APPLICATION FORM QUESTIONS

Basic Information

Full Name

Phone *

Email *

State *

About You

What inspired you to apply for therapeutic coaching at this time?

What are the main challenges you are currently experiencing?

(Examples: stress, anxiety, relationships, boundaries, confidence, career, emotional overwhelm)

What goals would you like to accomplish in the next 8–12 weeks?

How are these challenges affecting your daily life?

What have you tried so far to improve your situation?

Readiness & Commitment

On a scale of 1–10, how ready are you to invest time and energy into your healing and growth?

Are you open to learning new strategies and being guided through a structured coaching process?

Yes

No

Unsure

Are you able to commit to weekly or biweekly sessions?

Yes

No

Potentially

Are you currently seeing a therapist or coach?

Yes

No

Prefer not to say

if yes, please explain.

Wellness & Lifestyle

How would you describe your current wellness routine?

(Movement, sleep, nutrition, supplements, self-care)

Is there anything in your life right now that may influence your ability to participate fully in coaching?

(Work schedule, caregiving duties, health concerns, etc.)

Program Interest

Which coaching experience are you most interested in?

4-Week Reset Program

8-Week Healing & Elevation Program

VIP Therapeutic CoachingMulti Line

Not sure — please guide me

What do you want most out of this coaching experience?

(Clarity, emotional support, accountability, healing, structure, transformation, mindset shifts)

What would make this investment worth it for you?

Final Step

If accepted, how soon are you ready to begin?

Immediately

Within 1–2 weeks

Within a month

Is there anything else you would like me to know?

*

By providing my phone number, I agree to receive text messages from Garine Dalce. I understand I will receive two messages a month, data rates may apply. You can SMS opt out at anytime by responding "Stop".

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THERAPEUTIC COACHING APPLICATION FORM QUESTIONS

THERAPEUTIC COACHING APPLICATION FORM QUESTIONS

Join our Release and Reset Challenge and in Just 15 Days and you could:

© 2024 Garine Dalce. All rights reserved

© 2024 Garine Dalce.

All rights reserved